275. Epidemiology and Risk Factors of Vascular Access-associated Infections in Japanese Patients on Hemodialysis
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
  • IDWeek2015Poster.pdf (172.8 kB)
  • Background: The Centers for Disease Control estimated that about 37,000 episodes of vascular access-associated bloodstream infections occur every year in the US dialysis settings, posing significant health risk to the patients on hemodialysis. However, surveillance activity in the dialysis setting outside the US is generally low.  Furthermore, comorbidity of dialysis patients are diverse, and intensified infection control practices might be necessary toward certain patient population. The purpose of the study is to describe the epidemiology and identify risk factors for vascular access-associated infection (VAI) among Japanese patients on hemodialysis.

    Methods: Nationwide multicenter VAI surveillance system was established in 2008, using the CDC’s NHSN system. Targeted population was patients on hemodialysis due to end-stage renal disease. Incidence of VAI was calculated by the number of infection per 1,000 dialysis sessions. Data collected until December 2014 was analyzed.

    Results: The overall incidence of VAI throughout the period differed greatly by the type of access; 0.07 (87 VAI in 1,230,486 dialysis sessions) for arteriovenous (AV) fistula, 0.22 (12/54,324) for superficialization of brachial artery (SBA), 0.70 (41/58,248) for AV graft, 1.04 (32/30,759) for cuffed catheter, and 11.4 (244/21,364) for non-cuffed catheter. Non-cuffed catheter had significantly higher risk for infection than any other type of access. There was a decreasing trend over time in the incidence of all type of access except SBA. Non-cuffed catheter at the femoral site had 1.8 times (95%CI: 1.26-2.67) higher risk of VAI compared to that inserted at the internal jugular site. Patients with diabetes had significantly higher risk of catheter-associated VAI than non-diabetic patients (RR 2.47, 95%CI: 1.74-3.52).

    Conclusion: The risk of VAI varied among different types of VA. Non-cuffed catheter had extremely higher risk, therefore its use should be avoided.  If its use is inevitable, it should be inserted at the internal jugular site rather than femoral site.  Intensified infection control practices should be applied to diabetic patients with the catheter, because they had higher risk of VAI.

    Keita Morikane, MD, PhD, Infection Control, Yamagata University Hospital, Yamagata, Japan and Japanese Dialysis-associated Infections Surveillance Network


    K. Morikane, None

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